1454NOTE:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit 11
+ APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
DATE
June 8, 1992
LOCATION OF CONSTRUCTION Durango and Cortez
Subdivision Improvement Permit = Class I I
Minor Improvement Permit Class IV
S
(Street address or Description of Location)
PURPOSE OF CONSTRUCTION Move equipment Sketch (attach construction plans if appropriate)
DESCRIPTION OF CONSTRUCTION Mitsubishi 450 backhoe
DIMENSION OF INSTALLATION OR REMOVAL 12`6' wide 99'6" long
i
SIZE OF EXCAVATION, IF NEEDED
APPROXIMATE TIME WHEN WORK WILL BEGIN 6/8/92
HAUL ROUTE: FROM CORTEZ CIIL BURANGO.,
E/B'WASHINGTON ST. N?B.%"
CALLE TAMPICO E/B TO
CALLE RONDO.
APPROXIMATE TIME OF COMPLETION 6/8/92
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com- fy�� C�(L u.l(-FJ>
paction, and•.placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees to:
In demnify,.defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will, be started.
Comply with all, applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Sig ature of Applicant or Ag t
Standon Co. Inc. P.O. Box 903 Colton, CA 92324 (714)877-2126
Name of Applicant (please print) Business Address Telephone No.
Name of Contractor and Job Foreman Business Address Telephone No.
f •
Contractor's License No. City Business License No.
Golden Eagle Insurance Company TCR 14.;87 7.5
Applicant's Insurance Company Policy Number
FEES: Subdivision Improvement Permit — Class 111 005182 10 0335 06-08-92 i0
Public improvements: 3% of estimated construction costs 10 CASH i TOTAL' 1 10.00
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule c.
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
10.00
$ 10.00
Receipt No.
Received by Date
Recorded by
PERMIT VALIDATION
PERMIT NO.
DATE APPROVED 6/8/92
EXPIRATION DATE 6/8/92
DATE ISSUED
By .
Administrative Authority -
TELEPHONE: (619) 564-2246
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